Sarcopenia in cirrhosis: a systematic review

Introduction. Sarcopenia is a common complication and a frequently encountered feature in liver cirrhosis. Also, sarcopenia is a strong prognosis factor and a predictor of mortality in patients with advanced liver disease. However, in clinical practice, there are no well-established criteria for the diagnosis of this common complication of cirrhosis, the mechanisms which are involved are poorly understood and the possible therapeutic options are still undergoing randomized clinical trials.

Materials and methods. To summarize the actual understanding of sarcopenia in cirrhosis, a literature search was performed using PubMed, MedLine, and Web of Science, to find articles related to definition, physiopathology, and treatment of sarcopenia of these patients.

Results. A number of 30 papers that were suitable for this review were found. Most of them concluded that sarcopenia is a strong predictor of mortality, has a higher risk of hepatic encephalopathy and an increased health related cost in cirrhotic patients. The factors involved in this condition are far more complex than malnutrition and reduced protein intake, and include metabolic switch to the use of amino acids and fats to produce glucose. According to actual guidelines, beside moderate physical exercise and BCAA intake, therapeutic intervention with testosterone and ammonia-lowering therapies might have the potential to reverse sarcopenia in cirrhosis.

Conclusion. Improved understanding of factors such as underlying nutritional imbalances, amount of oral protein intake, dose, type and duration of supplementation and the compliance of physical exercise, should be the focus of further research with randomized controlled trials.